BMC Public Health

BackgroundSouth Africa introduced medical male circumcision (MMC) to reduce HIV incidence. Mathematical modeling suggested that targeting MMC services to men aged 20\u201334\ua0years could provide the most immediate impact on HIV incidence. However the majority of MMCs performed have been among males aged 6425\ua0years. We evaluated an intervention package to increase MMC uptake among men aged 25\u201349\ua0years.MethodsWe conducted a pre-post study to compare the proportion of men (aged 25\u201349\ua0years) presenting for MMC during the formative (Phase 1) and intervention (Phase 2) phases in Ekurhuleni, Johannesburg, South Africa. The intervention included infrastructure changes that separated adults from adolescents at the MMC site, an exclusive men\u2019s health club, adult-specific demand generation materials, and discussions with community members.ResultsOverall 2817 enrolled in the study with 1601 from Phase 1 and 1216 in Phase 2. A higher proportion of participants aged 25\u201349\ua0years accessed MMC in Phase 2 compared to Phase 1 (59.4% vs. 54.9%; Prevalence Ratio\u2009=\u20091.08; 95% Confidence Interval: 1.01\u20131.15; p\ua0=\u20090.019). Participants with multiple partners in the past 12\ua0months in Phase 2 were more likely to access MMC services compared to participants in Phase 1 (unadjusted Odds Ratio, 1.37; 95% CI:1.17\u20131.61; p\u2009<\u20090.001). After adjusting for age, multiple partners remained a risk factor in Phase 2 (adjusted OR, 1.39; 95% CI: 1.18\u20131.63; p\u2009<\u20090.001).ConclusionsThe \u201cExclusive Intervention Strategy\u201d was associated with a slight increase in the proportion of participants aged 25\u201349\ua0years accessing MMC services, and an increase in those with HIV risk behaviors, during the intervention phase. These findings may provide important insights to overcoming barriers for accessing MMC services among men aged 25\u201349\ua0years.Trial registrationThe study is registered at ClinicalTrials.gov, number NCT02352961.20182018-07-13T00:00:00ZU01 GH000522/GH/CGH CDC HHS/United States5U01GH00522/Center for Global Health/30005663PMC6044089660